SA releases involuntary mental health guidelines

The South African Department of Health has released the 72-hour Assessment of Involuntary Mental Healthcare Users, reports Health-e News. This 18-page guideline lists facility requirements for holding mental health patients for 72-hour involuntary assessments as well as the relevant procedures and guidelines for clinicians.

Released in 2012, the guidelines note involuntary admission and treatment of people living with mental illness, such as that involved in 72-hour in-patient assessments, remain controversial as they impinge on personal liberty and the right to choose. They also carry the risk of abuse.

Thus, guidelines stress that any person or establishment providing care, treatment and rehabilitation services to a person living with mental illness without consent must follow procedures set out in the Mental Health Care Act.

The document also states that provincial heads of health must submit a list of all facilities authorised to admit mental health patients without consent for 72-hour observation to not only the South African Police Department but also the National Health Department. This list must be updated annually. These facilities must meet a set of criteria including separate areas for adults and children, close circuit television monitoring, and panic buttons for staff.

The guidelines then move to describe aspects of clinical management of patients under 72-hour observation, including what types of patients may be at a high risk of suicide, the use of short-term sedation and South African Police Service obligations. A table of procedures to be followed when conducting 72-hour admissions is also provided. The document concludes by listing a number of scenarios where 72-hour admissions for patient assessment may be warranted.

The Department of Health has also released guidelines for the Seclusion and Restraint of Mental Health Care Users. Health-e News reports that they detail how healthcare workers may use seclusion and physical restraint with mental patients and caution that these actions should be seen as a last resort.

Released in 2012, the guidelines begin with a forward by Department of Health director general Precious Matsoso that acknowledges the vulnerability of mental health patients. The forward stresses that healthcare workers’ use of seclusion and physical restraint in regards to mental health patients should only be used in extreme circumstances as a matter of last resort.

The guidelines note that violent patients should only be physical restrained for brief periods during which medicine to control violence behaviour is administered. The document stresses seclusion and physical restraint may not be used as method to punish patients, and that patients and families should be educated about the use and purpose of seclusion and mechanical restraint.

Thus, the 16-page guidelines outline appropriate and inappropriate instances in which seclusion and physical restraint may be used. The document then goes onto to describe appropriate record keeping, and monitoring and evaluation of instances in which seclusion and restraint have been used. Finally, the guidelines detail the requirements for dedicated seclusion rooms in facilities.